MEDICARE: DR. JOHN LAWRENCE JACKSON PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC1900X	Counseling Psychologist	12900024-2501	UT

General Provider Information

NPI Number	:	1649973850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN LAWRENCE JACKSON PHD

Provider Business Mailing Address
First Line	:	3056 S 700 E APT C
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-1682
Country	:	US
Telephone Number	:	706-936-6422
Fax Number	:

Provider Business Practice Location Address
First Line	:	3056 S 700 E APT C
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-1682
Country	:	US
Telephone Number	:	706-936-6422
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2023
Last Update Date	:	03/24/2023

Similar Medicare Providers

1114377744 — DR. DANE JOSEPH NELSON D.M.D.
Practice Location Address:

5872 S 900 E STE 202
SALT LAKE CITY, UT
84121-1682

Practice Phone: 801-281-8433
Practice Fax: 801-281-8455

1205286655 — DR WESLEY F TILLMANN DMD PC
Practice Location Address:

5872 S 900 E STE 202
SALT LAKE CITY, UT
84121-1682

Practice Phone: 801-281-8433
Practice Fax:

1225614704 — MEG FROST CCC-SLP, LSLS
Practice Location Address:

1682 E YALE AVE
SALT LAKE CITY, UT
84105-1720

Practice Phone: 718-612-2318
Practice Fax:

1396710141 — MS. MEREDITH BARBARA SHEERON ATC
Practice Location Address:

9200 BURKE LAKE RD
BURKE, VA
22015-1682

Practice Phone: 703-426-1176
Practice Fax: 703-426-1172

1063553881 — DR. STEPHEN ROBERT LEITGEN DDS
Practice Location Address:

7324 BUSH LAKE DR
BLOOMINGTON, MN
55438-1682

Practice Phone: 952-303-3672
Practice Fax:

1275997082 — ACCESS DENTAL OF PARK LAKE PA
Practice Location Address:

1925 PARK LAKE DR
WACO, TX
76708-1682

Practice Phone: 972-514-1689
Practice Fax:

Directions to “ DR. JOHN LAWRENCE JACKSON PHD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.